NY hospital gets $80,000 fine, sharp rebuke
May 1, 2000 3 minutes read
NY hospital gets $80,000 fine, sharp rebuke
Pointing to an alarming number of deficiencies related to quality assurance, reporting of medical errors, inadequate staffing or poor use of staffing, and lack of proper procedures, the New York State Health Department has issued hefty fines against Staten Island University Hospital (SIUH) and its neurosurgery service.
State health commissioner Antonia Novello, MD, MPH, announced recently that the health department cited SIUH for 40 violations, resulting in fines totaling $80,000 against the hospital. The proposed fines amount to $2,000 per violation, the maximum monetary penalty allow-able under state law. The hospital also will be required to submit a plan of correction describing how each of the identified deficiencies will be addressed and what corrective action will be taken. In addition, the hospital must retain an independent consultant organization, acceptable to the state health department, to conduct an in-depth analysis of the management and oversight of SIUH’s department of neurosurgery service. Such analysis should include a thorough and comprehensive assessment of quality assurance, internal and external incident reporting, medical record documentation, and communication within the service and with the anesthesia department and the practitioner credentialing system. The analysis must produce a detailed report and recommendations for improvement for each of those activities, which must be provided to the hospital’s board of directors within 60 days, according to a report from the health department.
"SIUH is an institution that did not have sufficient systems in place to prevent serious medical errors, and it also did not have critical systems in place to identify and correct such errors," says Novello. "The hospital must correct their deficiencies immediately and make certain such problems do not recur."
Further, the SIUH also must obtain an independent consultant to analyze and suggest hospitalwide improvements to quality assurance and credentialing systems within 120 days. Once the hospital receives either consultant’s report, recommendations must be implemented within 30 days, providing they are acceptable to the health department.
The hospital also will be required to submit quarterly reports to the health department for a period of one year commencing with the effective date of the stipulation and order. Those reports must detail activities undertaken to implement corrective actions and the assessment of the effectiveness of those corrective measures.
In a letter dated Feb. 28, 2000, to SIUH, the health department cited 40 violations in these six categories:
1. Poor judgment and lack of surgical preparation. Examples include starting a major neurosurgical procedure without having a copy of the CAT scan or X-ray or appropriate diagnostic test results in the operating room; not having sufficient blood supply available in the operating room; not performing appropriate preoperative testing before a procedure; requesting advice from a salesman in the OR; and using an inappropriate surgical device for the procedure being performed.
2. Inadequate preparation of the surgical team and lack of sufficient communications among the surgical team. Examples include lack of discussion among the surgical team about the potential for doing a more extensive surgical procedure and assuring that the necessary preparations for that procedure were in place; concerns about the extent of a surgical injury not being fully identified or discussed; and the possibility of an incorrect site for procedures not being appropriately identified by surgical team members.
3. Inappropriate use of physician’s assistants. Physician’s assistants routinely served as the first assistants in major surgical procedures. The health department says that is a clear violation of the State Hospital Code and limited the advice and assistance available to the surgeon in complex, life-threatening procedures.
4. Inadequate quality assurance. The quality of care deficiencies cited by the health department were not identified by the hospital’s quality assurance system. No corrective action was proposed or implemented.
5. Ignoring the complaints that staff made to the hospital. Hospital staff raised concerns within the hospital regarding the quality of neurosurgery care. No action was taken by the hospital to review those concerns until February 2000. When the chief neurosurgery anesthesiologist indicated he would no longer work with a specific neurosurgeon in December 1999, such action should have triggered immediate review by the hospital’s administration, medical staff leadership, and quality assurance process. Nothing happened until early February 2000.
6. Failing to report the incidents. The hospital did not report any of the cases that were cited in the statement of deficiency to the health department.
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